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General NPI Number Information
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NPI Number | 1740370071
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Entity Type | Individual
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Provider Name | SUSAN G LOVE DPM
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 1717 GARDEN ST
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City | TITUSVILLE
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State | FL
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Zip | 32796-5002
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Country | US
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Telephone | 321-267-5577
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Fax | 321-264-0724
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Provider Business Mailing Address
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Address Line | 1717 GARDEN ST
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City | TITUSVILLE
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State | FL
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Zip | 32796-5002
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Country | US
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Telephone | 321-267-5577
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Fax | 321-264-0724
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO 1702
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License Number State | FL
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